The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.
Historically, it’s rare for commercial payers to have drug formularies for medical benefits, but that’s changing. In effect, health plans are, in some ways, choosing drugs they prefer, based on their judgments about safety and efficacy, as well as availability, lowest net cost, and how a drug is administered.
The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.
They are far less common than many chronic conditions. But by some measures, the financial and health toll from inflammatory bowel disease, rheumatoid arthritis, and psoriasis is comparable to stroke and lower back pain.
Hub programs are growing in popularity as a way for pharmaceutical companies to combat the clout of employers, health plans, and PBMs. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.